Friday Afternoon Rituals—Here Comes the Weekend!

Party Weekend” – Joe “King” Carrasco

Fight for Your Right (To Party)!” – Beastie Boys

“We Just Wanna Dance” – The Flirts

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Mom & Dad’s dog Sophia, too pooped to party…

My favorite radio station, WHFS, had a ritual every Friday afternoon to start off the weekend, back in the day. DJs Weasel and Bob Here would exchange pleasantries as they exchanged shifts, and would launch in to the same set of songs at the same time every Friday (with occasional additions). The songs above, as a matter of fact. These were selected to get your spirits up and blood pumping as the work week morphed into the weekend. It was a ritual which became a tradition for ‘HFS and loyal listeners, fondly recalled to this day, even though the radio station itself is long gone and the DJs dispersed. Every Friday I seemed to be in my car at just the right time, cranking up the volume, celebrating the end of my week and the coming weekend.

Doctors also prepare for Friday afternoons, bracing for a ritual of sorts. Any time after 3:00 it starts, lasting until well after the offices close and the weekday schedule transitions to the after-hours weekend routine. It is observed by most physicians, regardless of specialty, whether they practice in the hospital or in an outpatient office.

Suddenly on Friday afternoons, it occurs to people that the weekend will be starting, and the availability of the doctors and their offices, labs, imaging, testing and what-have-you will be limited. So all of the problems languishing in and out of the hospital take on a renewed sense of urgency, and must be taken care of Right Now, before the weekend hits. Nothing can wait another hour or day, and certainly not until Next Week (Monday)! Continue reading

The Convert: The Doctor Embraces Social Media

“Waaaah-Hoo!!” – Slim Pickins as Maj. ‘King’ Kong, riding the bomb in “Dr. Strangelove”

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St. Louis Cathedral, Jackson Square, New Orleans

I am converted. Like many doctors, I was very leary of social media, wary about using it, skeptical of its professional value. Especially Twitter, but really all of the platforms. No longer: I have embraced social media, and it has embraced me.

I feel a little bit like Dr. Strangelove, only the subtitle is now “How I Learned To  Stop Worrying and Love Social Media.”

Like most converts, I find myself an enthusiastic proselyte, spreading the good word to friends and colleagues, regaling them with my new-found experiences using Twitter, Facebook, LinkedIn and the like. Discovering more sites and platforms, like Sermo, Doximity, Docphin, and Medstro, to name a few. (Disclosure: I have no financial or other arrangement with any of these, but have written for both Sermo and Medstro, and am a discussion panelist later this month on Medstro). The list goes on and on, and keeps growing. Websites and apps abound; they all go mobile, so much content to explore. So much time to waste!

“Waste of time” is the most common and scathing criticism leveled at social media by my physician friends and colleagues who have not yet seen the light. Continue reading

Embracing Eternity

Eonia I Mnimi (Eternal Memory) – Greek Orthodox Funeral Blessing

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Sunset approaching after the storm, Falmouth, MA

“Have you ever seen anyone die before?” my cousin asked me, from across the bed.

“Sure I have, plenty of times,” I answered.

We were flanking her father, my uncle (really, my mother’s cousin, but extended Greek families are complicated; suffice it to say that our families are very close). He had just taken his last breath.

*****

My uncle had been declining for several years with Lewy Body Dementia, and it had been accelerating over the past year or so. It was stealing him away, his mind anyway, though until lately his body remained strong. He wasn’t even on any medications, except the Exelon patch and Namenda to slow the dementia, remarkable for his 88 years. Last fall he had an “episode” for which he was hospitalized, and his doctors indicated that it was likely progression of his disease; so from then on, he had been cared for with hospice assistance. His death was certainly not imminent, within days or weeks, as one usually thinks with hospice involvement, but it was inevitable. There was not much to do from a palliative point-of-view, there simply wasn’t anything else to add to or to enhance his care. But as he declined, his family— especially my cousin — were going to face some hard choices about how best to care for him. The resources in the home, even with hospice and aides to help in his care, were rapidly becoming inadequate. As it turned out, they did not have to worry any more about breaking the promise they made to him.

*****

That afternoon I went to see my uncle, who had been living with my cousin for the past few years. I had been texting and emailing with her over the prior week, after he had another “episode”—this time more severe, like a seizure or even a stroke, from which he was not waking. He had not had anything to eat or drink for about a week, and had stopped voiding for the past day or so. He would rouse slightly, then drift back to sleep. She indicated that his breathing had started to become irregular at times, with long pauses. He had small doses of morphine and ativan sublingually to ease his breathing, though it is hard to say if those tiny doses did much, or how much was even absorbed.

When I walked in to the room with her, to sit for a while and keep him — and her — company, the breathing pattern was immediately recognizable to me. It was the classic, end-stage pattern of Cheyne-Stokes respirations, the crescendo-decrescendo pattern punctuated by apnea, pauses ranging from 10 seconds to nearly a minute, before the whole pattern repeated. He was not in any discomfort, there was no distress. It bothered us more than him. It also meant that the end was coming soon, some time in the next hours. Continue reading

The Paradox of Physician Communication

“Communication Breakdown, It’s always the same, I’m having a nervous breakdown, Drive me insane!” – Communication Breakdown, Led Zeppelin

“Oh why can’t we talk againDon’t leave me hanging on the telephone!”  – Hanging on the Telephone, Blondie

Carriage line, Jackson Square, New Orleans, LA

Carriage line, Jackson Square, New Orleans, LA

I honestly don’t know how they did it, how doctors practiced and communicated effectively in the days before our modern technology, with computers, pagers, and cell phones (not to mention laptops, iPads and tablets, and smart phones), but they did.  All of these have been a ubiquitous presence my entire practice career; each has insinuated itself rapidly and completely into the lives and practices of physicians.  I think most physicians would feel lost or disoriented trying to practice without all of this technology today (well, maybe not pagers, which are phasing out rapidly as cell phones and smart phones leave fewer gaps in coverage).

There are so many ways to be in touch and in communication today, making us available at any time, in any place, limited only by the reach of our devices.

It certainly feels as if physicians live their lives constantly plugged in and available, all of our devices turned on even if we are off. We feel as if no time or place is sacred or spared, and must make it clear to others and arrange those times when we must be free from interruption. Even then, there is a barrage of communication that awaits us when we plug back in. There is an expectation of constant and uninterrupted availability. There is anxiety when the communication fails — a dead battery, or poor signal when we thought we were in a place with coverage — only alleviated when we are once more connected.

So with all of this ability to communicate, all of this technology, our electronic leashes keeping us tethered, why aren’t we communicating with each other? Why is our communication so ineffective? Continue reading

Is There a Provider in the House?

“I said Doctor, Doctor, Mr. M.D. – Can you tell me what’s ailing me?” – Good Lovin’, The Grateful Dead

“I’m a doctor, not a mechanic.” – Dr. Leonard “Bones” McCoy, “Star Trek”

“I’m not a doctor, but I play one on TV. ” – Chris Robinson/Dr. Rick Webber of  “General Hospital”

 

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Ceiling, Bellagio Hotel Lobby

I enjoyed an email exchange with a couple of long-distance friends the other day, Gina (an author and journalist) and Eric (a computer/IT professional), prompted by the follow-up questionnaire Gina received after her recent doctor visit and procedure. Throughout the form, it asked her to evaluate the various aspects of her interaction with her provider. 

This struck her as odd and funny, and we engaged in a generally humorous exchange. A couple of really serious points were made as well.

First, though, it made me think of a new game, playing around with words. Take any fictional character from books, film, television; any famous poetry, literary passage, or song lyric; any famous person or historical figure that contains or references the title “doctor” or “physician”, and substitute “practitioner” or “provider.” Dr. Who, Dr. Strangelove, Dr. Zhivago. Christ the Physician. Dr. Spock (both of them), Dr. Koop. Dr. Gawande. “Doctor, my eyes…”, “Doctor, Doctor, tell me the news…” , “Is there a doctor in the house?” You get the idea. Stilted, clumsy, and the result is often strange if not creepy. We can play the same game with references to the word “patient”, substituting “customer” or “client”.

But wait, we already play that game, it is a daily interaction, and we are getting shockingly accustomed to it. Continue reading

Running Late: Confessions of the Late Doctor

“I’m late! I’m late! For a very important date! No time to say hello, goodbye! I’m late! I’m late! I’m late!” – The White Rabbit, Disney’s Alice in Wonderland 

“Oh dear! Oh dear! I shall be too late!” – The White Rabbit, Lewis Carroll’s Alice in Wonderland

“Which form of proverb do you prefer Better late than never, or Better never than late?” – Lewis Carroll

“And it’s too late, baby, now it’s too late, though we really did try to make it.” – Carol King, It’s Too Late, Tapestry

Clock Tower, Mary Lyon Hall Mount Holyoke College, South Hadley, MA

Clock Tower, Mary Lyon Hall
Mount Holyoke College, South Hadley, MA

It is in the very words, running late. It is not walking late, or strolling late, or even meandering late. It is always running late, the phrase itself active, implying urgency and speed, rush and anxiety. The distress, just like the White Rabbit. The dash to the next appointment in a crammed tight, overfilled schedule.

Running late. It is the bane of doctors everywhere. I can’t stand it, I don’t think any doctor is happy when it happens. It is distressing, and feels unavoidable. I feel as if I can’t stop it, can’t prevent it.

It is almost to the point that I am amazed if I am ever actually on time. Office schedules overbooked to compensate for no-shows and to accommodate urgent patients, and operations are scheduled with an optimistic slant on the time needed. All of it collapsing with the first surprise, the extra problem, the emergency. The schedule so carefully crafted, like a house of cards, and just as vulnerable to come crashing down at the slightest perturbation, the tiniest shift. These shifts and adjustments snowball throughout the rest of the day, bigger and bigger, later and later, sweeping me along the avalanche path.

Run, run, run. Rush, rush, rush. Office to hospital, hospital to office. Continue reading

Like a Surgeon: About That Surgical Stereotype

“A good surgeon also has to have compassion and humanity, and not be someone who is arrogant and difficult to deal with.” Dr. Thomas J. Russel (former Executive Director of the American College of Surgeons, New York Times interview

“Like a Surgeon” – Weird Al Yankovic

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Operating, like a surgeon.

I hear the comments frequently; in fact, I hear them all the time. At work I hear them from staff, from patients — even from non-surgical colleagues. I hear them away from work, when meeting new people who find out that I am a physician and a surgeon. I think many women surgeons hear the same:

       “You’re not like a surgeon. You’re not like other surgeons.”

The comments tend to run along the same lines. You don’t look like a surgeon. You don’t act like a surgeon. You’re too nice, too caring, too compassionate, too thoughtful, too communicative (sometimes, too pretty). Most of the time, the comments are offered as compliments. They are proffered in a context attempting to make me feel welcomed and appreciated.

I understand these comments are meant as compliments, but what do they say about surgeons? And even more specifically, about women who are surgeons?

We all have stereotypes.  They are a shortcut we all use to help us understand the people and world around us, especially the unfamiliar. But the unfamiliar becomes familiar, and people and groups evolve and change. Stereotypes are mired in ignorance and misinformation, and they help us to resist that change. At that point they do not serve any purpose, and in fact, harm rather than help.

These comments and compliments speak to the stereotypes of who we think our doctors are, what surgeons are like, speaking volumes about the image of surgeons. It is an image as unfair to men as it is to women. Continue reading

Snow Day

“When I no longer thrill to the first snow of the season, I’ll know I’m growing old.” – Lady Bird Johnson

“The snow doesn’t give a soft white damn whom it touches.” – e. e. cummings

“Come in, she said, I’ll give you shelter from the storm.” – Bob Dylan

Snowy Day, Winter 2014

Snowy Day, Winter 2014

 I am not that different now than I was as a kid, with the prospect of a snow storm looming in the future. As the storm approaches and the forecast comes in to focus, I feel the spark of excitement building in my core. I can’t help but feel this quickening, the magnitude paralleling the magnitude of the anticipated storm.

Here in New England, we are bracing for a storm of “historic magnitude”, “Top 5” , whatever that means. A nor’easter predicted to blow in and lay down between 2 and 3 feet of snow where I am. What a thrill!

Things are different now, of course, than in childhood. Instead of the delicious prospect of a bonus day off from school, spent “helping” dig out, playing in snow, and getting Mom or Dad to make up some hot chocolate or a warm nourishing comfort-food meal, more practical preparations and planning take precedence.

The planning is ever present. As a doctor, and especially an on-call general surgeon, it is critical that I be able to get to the hospital regardless of the weather. Continue reading

In Harm’s Way, the Tradition and Legacy of Medicine

 “There isn’t any such thing as an ordinary life.” – Lucy Maud Montgomery

“Heroes are ordinary people who make themselves extraordinary.”Gerard Way

Clouds, Sunset after winter storm, Falmouth, MA

Clouds, Sunset after winter storm, Falmouth, MA

My colleague, Dr. Jesse Ehrenfeld, is currently on leave from his academic anesthesia practice as well as from his post as Speaker of the House of Delegates for the Massachusetts Medical Society to serve as Lt. Commander Jesse Ehrenfeld, Combat Anesthesiologist in Kandahar, Afghanistan. We all appreciate the sacrifice he is making, putting himself at risk and in harm’s way.

This sacrifice is part of the great tradition of medicine, a tradition that compels physicians into war zones to take care of the injured. It is the same tradition that has us traveling to help treat diseases for which we may not have a cure or even a name yet, or into areas near and far ravaged by natural disasters.

As physicians we imagine that the risks we take are contained in far-flung locations or defined by the time it takes to start the recovery from disaster. Taking these risks is part of our  commitment and calling, our responsibility. These are not every day, ordinary events and circumstances. They are extraordinary, and we rise to those challenges, to be extraordinary ourselves to take care of them. Then life returns to normal.

But what about yesterday, an ordinary crisp sunny winter day in Boston? When at about 11 a.m. a man entered the cardiothoracic clinic at the revered Brigham and Women’s Hospital and  fatally shot surgeon Dr. Michael J. Davidson  before taking his own life. The patients, the doctors, the nurses and staff in the hospital and clinics were in the throes of an ordinary day, no grand events planned in the city, no special holiday.

In short, it was — or should have been — an unremarkable day. Continue reading

Help the Doctor! When Systems & The System Fail Physicians

“Help, I need somebody! Help, not just anybody! Help, you know I need someone, help!” –Help!, The Beatles

“We are all here on earth to help each other; what on earth the others are here for I don’t know.”  W. H. Auden

After the storm, Falmouth, MA

After the storm, Falmouth, MA

Help the doctor!”

I’m sure most surgeons have heard this exasperated statement at some point in the operating room. It is said with that special mix of frustration, irritation, and sarcasm, usually when things aren’t going smoothly. When there is fumbling or bumbling, when the assistance, the systems, the help are failing, breaking down.

That same emotional mix is permeating medicine; this statement of exasperation could well be the new rallying cry for physicians.

Since I have started to write, and to post to this blog, I have also started to read even more of the blogs out there, primarily the medical writing. Part of writing is reading. As I write about the subjects and issues and events that touch my professional life, I have noticed that many of the same are on the minds of my colleagues. They likewise broadcast their thoughts to the universe. I am conflicted, I confess. I don’t know whether I feel a tinge of disappointment that my observations and epiphanies are not so singular or earth-shattering, being shared by others; or vindicated, to see so many with similar experiences leading them to similar observations and conclusions. We each are unique, though, with slightly different angles as we approach the topics, like the facets on a diamond. But, we are all on the same gemstones, and like the facets, reflecting more light, illuminating the stone. So I will claim my facet on the gem, and hope to illuminate. I add my voice to the chorus.

One thing that shines through so clearly to me as I read, as I go to medical meetings, or even attend any gathering involving two or more physicians, is the general sense of frustration. It touches all doctors, regardless of specialty, employment status, or even level of training or experience.

It comes as no news to observe that our capital-S System is broken, and that our lowercase-s systems are failing us. I think that the root of the problems with both share a common underlying cause.

These systems no longer help the doctor. Continue reading